Ellen de Kort

80 Chapter 5 Table 2. Characteristics of included studies - continued First author, year, country Study design Premedication Lemyre B, 2004, Canada Randomized study SG: morphine CG: placebo Oei J, 2002, Australia Randomized controlled non- blinded trial SG: morphine, atropine, suxamethonium CG: none Buthada A, 2000, USA Randomized placebo controlled non-blinded trial SG: thiopental CG: placebo Naulaers G, 1997, Belgium Prospective observational Methohexital Abbreviations: CG, control group; GA; gestational age; SG, study group. Table 3. Objective scoring systems Level of sedation Highest sedation Sedation score 4 3 Motor response to firm stimulus No movements Movement on firm stimulus Definition Effective sedation = score 3 or 4 Relaxation score 4 3 Extremities tone Hypotonic Mildly hypotonic Definition Effective relaxation = score 3 or 4 Good sedative state -2 -1 Crying/irritability No cry with painful stimuli Moans or cries minimally with painful stimuli Behavior state No arousal to any stimuli, no spontaneous movement Arouses minimally to stimuli, little spontaneous movement Facial expression Mouth is lax, no expression Minimal expression with stimuli Extremities tone No grasp reflex, flaccid tone Weak grasp reflex, decreased muscle tone Vital signs No variability with stimuli, hypoventilation or apnea <1% variability from baseline, with stimuli Definition Good sedative state = total score on all 5 items -7 to -3